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I have some doubts that the code of practice will make any more difference than all the guidance and circulars that have preceded it. What constitutes best infection control practice, as we have just heard from the hon. Member for Lewisham, Deptford (Joan Ruddock), is already clear. There is plenty of guidance around to be followed. For example, in 2000 the Department of Health issued a circular setting out a programme of action for the NHS on the management and control of hospital infections. To this day, there has been no national audit of compliance with that circular, and Health Ministers have consistently made it clear that the Government have no plans to undertake such an audit.
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Ensuring compliance with the existing guidance should have been a priority, and the fact that a statutory code is now felt to be necessary is, in truth, an admission of eight years of failure by this Government in controlling infections both in the community and in our hospitals.
The problem has been where infection control sits in relation to the Government's other health priorities. From reading the summary of responses to the Department's consultation on the code, it is clear that many are worried that the guidance in the code will
That is absolutely rightit must do that. It is disturbing that more than a year after the National Audit Office published its progress report, that remains a concern among many in the NHS. The NAO found, at the time of its report last year, that half of NHS managers were struggling to reconcile the competing demands of Government waiting time targets and the management of hospital infections. The question is, will the code make clear what takes precedencepolitical targets or infection control? The response to my earlier intervention suggested a "have the cake and eat it" approach to that question, and to the issue generally. I hope that the Minister will clarify the matter later.
Against a background of increasing financial instability and rising deficits there is cause for concern that NHS organisations will struggle to tick all the Government boxes and meet their obligations under the new code, but if a statutory code of practice gives infection control the priority that it needs, I for one will support it and consider it a worthwhile measure.
Part 1 deals with the partial ban. Like others who have spoken today, I hope that a majority in the House will amend the Bill to provide for a comprehensive ban on smoking in enclosed public places. For many, it is a question of social justice. How can it be right to legislate to protect workers from the harmful effects of second-hand smoke in the majority of workplaces, and then fail to extend that protection to bar workers, who are often most at risk? During an average eight-hour shift, a bar worker can inhale environmental tobacco smoke that is equivalent to smoking a pack of 10 cigarettes a day. It is the overwhelming evidence that smoking harms non-smokers that leads me to support the introduction of a comprehensive ban on smoking in enclosed public places. If it were simply a case of smokers putting their own lives at risk I, as a Liberal, would respect their right to make that choice, but the right to smoke must be balanced against the rights of non-smokers in general and workers in particular.
Second-hand smoke does harm. It can and does kill. There is no safe level of exposure to it. Last November, the Scientific Committee on Tobacco and Health reported that exposure to second-hand smoke significantly increased the risk of heart disease and lung cancer in non-smokers. In April this year, a study published by the British Medical Journal estimated that it was responsible for 617 deaths a year. Those are preventable deaths, but the health effects are much wider. According to Asthma UK, four fifths of the country's 5 million asthma sufferers say that second-hand smoke makes their condition worse.
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I believe that a ban on smoking in enclosed public places must be seen first and foremost as a health and safety measure. Protecting workers from second-hand smoke should be the goal. The Government's policy, however, does not achieve that end. It is not sufficient to argue that because the vast majority of workplaces will be covered by a ban, it is somehow acceptable to set aside the evidence and allow bar workers to be exposed to second-hand smoke. Proposals for a smoke-free buffer zone around the bar are pointless, unless the Government plan to legislate to change the laws of physics and stop smoke from drifting around the bar.
Ventilation is not an answer. The best that it can offer is comfort for the customer. It does not provide safety for staff because it does not extract carcinogens from the atmosphere. Research suggests that more than 10,000 air changes an hour would be necessary to achieve ambient levels of particulates. That is equivalent to a mini-tornado blowing through the pub.
Dr. Murrison : Will the hon. Gentleman draw a distinction between an ambient atmosphere and an occupational setting? When considering occupational settings of the sort that he describes, should we not consider occupational exposure standards that could be attained through the engineering measures to which he has referred?
Mr. Burstow: On the basis of the research that the Select Committee has seen so far on the efficacy of ventilation systems, in terms of both cost-effectiveness and practicalities, I am not convinced that that can be achievednot least because the level of air change required for the achievement of the necessary safety standards would be high enough to make patrons uncomfortable. It is likely to be really effective only when the bar is empty, which rather defeats the purpose.
A disproportionate amount of time and money will be invested in defining, and then enforcing, the exemptions. The more complex the regulatory system, the greater will be the burden on business and the cost to consumer and taxpayer. As we have heard, the Health Committee has received evidence from the hospitality trade, the Health and Safety Executive and local authority enforcement officers. They all agree that a partial ban will be more expensive to enforce.
During the Committee's visit to Dublin earlier this month, it was clear that the ban in the Republic was working well. One reason is that it is easily understood and, as a result, largely self-enforcing. Compliance is currently 94 per cent. Enforcement action has been necessary, but in only a small number of cases. The Secretary of State cited experience in Norway as evidence that comprehensive bans do not come along in one go, but must come along in stages. In Norway, however, the partial ban was abandoned in favour of a comprehensive ban because it was proving unfair, unpopular and unenforceable. As my hon. Friend the Member for Northavon (Steve Webb) said, why should we make the same mistakes in this country and then implement a full ban later?
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The fact of devolution should not mean that Ministers in Westminster ignore the lessons from Edinburgh and Cardiffand, indeed, from non-devolved Belfast. Why should Health Ministers in Scotland, Wales and Northern Ireland be wrong and Health Ministers in England be right? It has been suggested that Ministers here feel that England is not yet ready for a comprehensive ban. Even if we accept that argument, however, surely it is the Government's duty to act on the basis of scientific evidence.
Let me respond briefly to points made by the hon. Member for Lewisham, Deptford and the right hon. Member for Charnwood (Mr. Dorrell). Surely the choice is between comprehensive and comprehensible legislation after we in the House of Commons have debated and framed the law, and allowing the courts to drive bans through by means of individual decisions under health and safety legislation or precautionary steps taken by employers. I do not consider the latter a satisfactory basis on which to proceed. We should be legislating in a comprehensive fashion.
During the Select Committee's visit to Dublin, I was struck by how quickly public opinion had moved on in the Republic. There is now a tangible sense of pride at what has been done in Ireland. The Irish Government saw the need and gave a lead, and that is what should happen here. Public opinion in England is moving and it is time for the Government to move as well, not least on the issue of exemption for bars that do not serve food. Of the 41,833 people who responded to the Department's questionnaire, more than 90 per cent. said that there was no basis on which they would accept such an exemption.
The Secretary of State has achieved an unusual feat. At the same time as dividing the Cabinet, she has managed to unite ASH and the British Beer and Pub Association in opposition to a partial ban. Public opinion in England is already more supportive of a comprehensive ban than it was in the Republic of Ireland before its introduction there.
There can be no doubt that a partial ban will widen health inequalities, as a number of Members have pointed out. According to a survey by ASH, following a partial ban two out of five pubs would close their kitchens permanently and adopt non-food status so that they could allow smoking. Last Thursday, when the Health Committee took evidence from the chief medical officer, Sir Liam Donaldson, I asked for his professional opinion on a partial as opposed to a comprehensive ban in terms of health inequalities and outcomes. He said
He said that it put Britain among the laggards of public health policy internationally rather than among the global leaders. Laggards not leaders: that must surely be the consequence of ignoring the chief medical officer's compelling advice.
When I intervened on the Secretary of State earlier, I mentioned the regulatory impact assessment. The detailed tables show that the difference between a partial and a comprehensive ban is 200 preventable deaths a year. The idea of exempting pubs that do not serve food is ill-conceived. It is a classic case of doing what is expedient rather than what is right. Health policy should
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be evidence-based, not evidence-blind. I agree with the chief medical officer that when it comes to the question of freedom, the smoker's right to smoke stops at my nose.
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